Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2655

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-30656761

Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.

Address: 2000 Argentia Road, Plaza 5, Suite 101

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5N2R7

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

27-JUN-12

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

Unknown

Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.

Active(s)

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PMRA Registration No. 27521      PMRA Submission No.       EPA Registration No.

Product Name: Home Defense Max Perimeter Indoor Insect Control Ready To Use

• Active Ingredient(s)
  • PERMETHRIN

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Res. - In Home / Rés. - à l'int. maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Dry mouth

• Nervous and Muscular Systems
  • Symptom - Headache

• General
  • Symptom - Chemical taste in mouth

• Respiratory System
  • Symptom - Irritated throat
  • Symptom - Other
  • Specify - Phlegm in throat

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Application

Contact with treated area

Amount of time between application and contact 7

Day(s) / Jour(s)

What was the activity? entering primary residence

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-30656761- The reporter indicated he had been exposed to an insecticide containing permethrin. The reporter indicated he had used the product in his home just over one week prior to his initial report. He did not describe application. He had not re-entered the home for one week. He indicated he had re-entered the home/application site two days prior to his initial report. He had since that point experienced headache, dry mouth, throat irritation, had noted an unpleasant taste in his mouth and had phlegm in his throat. The caller was advised of the potential for minor respiratory irritation that may be experienced following the exposure to the aromas of some insecticides. He was advised of means to minimize his discomfort, clean up measures, and the threshold at which he may seek medical assistance. No follow up was obtained from this reporter. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.